DAR File No. 31645

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-59

Audiology-Hearing Services

NOTICE OF PROPOSED RULE

DAR File No.: 31645
Filed: 07/01/2008, 09:43
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to repeal and reenact Rule R414-59 to clarify audiology-hearing services for Medicaid recipients.

Summary of the rule or change:

The reenacted rule clarifies that audiology-hearing services are optional and refers Medicaid recipients to the Audiology Provider Manual for a complete list of service criteria. The previous rule only lists in general terms some of the services and criteria for audiology-hearing services. In addition, the new rule adds a reimbursement section that refers providers and recipients to the State Plan for reimbursement information.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

Anticipated cost or savings to:

the state budget:

No significant impact to the state budget is expected. The rule clarifies ongoing Medicaid policy for audiology-hearing services. The majority of Medicaid recipients will receive the same services under this rule. On balance it is expected to be budget neutral.

local governments:

There is no budget impact because local governments do not fund or provide audiology-hearing services to Medicaid clients.

small businesses and persons other than businesses:

No significant impact to business is expected. The rule clarifies ongoing Medicaid policy for audiology-hearing services. The majority of Medicaid recipients will receive the same services under this rule. Providers and recipients should find it easier to determine what is available.

Compliance costs for affected persons:

There are no compliance costs because this change only clarifies ongoing Medicaid policy for audiology-hearing services.

Comments by the department head on the fiscal impact the rule may have on businesses:

Audiology-Hearing Services are an optional service in Medicaid. This rule should make it easier for providers and recipients to know what services are authorized and may have a small positive fiscal impact on business. The current level of authorized funding in this category should not change as a result of this rule. A. Richard Melton, Acting Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/14/2008

This rule may become effective on:

08/21/2008

Authorized by:

Richard Melton, Deputy Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-59. Audiology-Hearing Services.

[R414-59-1. Introduction and Authority.

(1) The Audiology-Hearing Program provides audiology and hearing services to meet the basic audiology and hearing needs of Medicaid clients.

(2) Audiology-hearing services are authorized by 42 CFR, Subsection 440.110(c)(1)(2), October 1994 edition, which is adopted and incorporated by reference.

 

R414-59-2. Definitions.

(1) The definitions in the Speech-language Pathology and Audiology Licensing Act, Title 58, Chapter 41, apply to this rule.

(2) In addition, "Client," "Categorically Needy", "Medically Needy", and "Provider" have the same meanings as defined in R414-1-1.

 

R414-59-3. Client Eligibility Requirements.

Audiology-hearing services are available to Categorically Needy and Medically Needy individuals.

 

R414-59-4. Program Access Requirements.

(1) A physician provider must refer a client for audiology-hearing services before the client can receive these services.

(2) The referral form must state that the medical examination determined that the conditions causing the hearing loss are not medically correctable. It must also state that conditions medically treatable were identified and treated prior to this referral.

(3) The referral form must also state that there is no medical reason, dysfunction, or hearing impairment that would preclude the use of a hearing aid.

 

R414-59-5. Service Coverage.

(1) A provider may provide audiology-hearing services for a client, including: testing, examination, evaluation, recommendations, hearing aid evaluation, prescription for a hearing aid, ear mold, fitting, orientation, and follow-up. Audiological habilitation includes, but is not limited to, speech, hearing, and gestural communications. All services must be related to medical need. Treatments for social, educational, and developmental needs, while important to the individual, are not covered services.

(2) Only a licensed audiologist may perform audiology examinations and hearing aid assessments.

(3) Hearing aids are a covered service when hearing loss criteria are met, as outlined in the provider manual.

(4) Either an audiologist or a hearing aid supplier may provide hearing aids. All requests for hearing aids must include the results of audiology examinations performed by a licensed audiologist.

(5) Medicaid shall not reimburse an audiologist or a hearing aid supplier for hearing aids that are not guaranteed by the manufacturer for at least one year.]

R414-59-1. Introduction and Authority.

(1) This rule governs the provision of audiology-hearing services.

(2) This rule is authorized by Sections 26-18-3 and 26-1-5.

(3) As required by Section 26-18-3, the Department provides these services in an efficient, economical manner, safeguarding against unnecessary, unreasonable, or inappropriate use of these services.

 

R414-59-2. Definitions.

(1) The definitions in the Speech-Language Pathology and Audiology Licensing Act, Title 58, Chapter 41, apply to this rule.

 

R414-59-3. Services.

(1) Audiology-hearing services are optional services.

(2) Audiology-hearing services are limited to services described in the Audiology Services Provider Manual.

(3) The Audiology Services Provider Manual specifies the reasonable and appropriate amount, duration, and scope of the service sufficient to reasonably achieve its purpose.

(4) Audiology-hearing services may be provided to an individual only after being referred by a physician. All audiology-hearing services must be provided by a licensed audiologist.

 

R414-59-4. Services for Individuals Eligible for Optional Services.

(1) An individual receiving audiology-hearing services may receive audiology services as described in the Audiology Provider Manual.

(2) An individual receiving audiology-hearing services must meet the criteria established in the Audiology Provider Manual and obtain prior approval if required.

 

R414-59-5. Reimbursement.

Audiology services are reimbursed using the fee schedule in the Utah Medicaid State Plan and incorporated by reference in R414-1-5.

 

KEY: [m]Medicaid, audiology

Date of Enactment or Last Substantive Amendment: [January 24, 1996]2008

Notice of Continuation: November 22, 2005

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3